- 8 yr old mn Miniature Schnauzer with acute onset shaking, vomiting, and hematuria
- Labwork shows increased BUN (70), increased creat=2.5, BP=180, WBC ct=25,000, normal platelet count, slightly prolonged PT and PTT
- Abdominal US shows mobile blood clot in the bladder, normal bladder and trigone walls, normal prostate, bilateral renomegaly (5.3cm in length), increased cortical echogenicity with respect to the liver and spleen, decreased corticomedullary definition, mild bilateral renal pelvic dilations (dog is on IV fluids), and a small amount of retroperitoneal ef
- 8 yr old mn Miniature Schnauzer with acute onset shaking, vomiting, and hematuria
- Labwork shows increased BUN (70), increased creat=2.5, BP=180, WBC ct=25,000, normal platelet count, slightly prolonged PT and PTT
- Abdominal US shows mobile blood clot in the bladder, normal bladder and trigone walls, normal prostate, bilateral renomegaly (5.3cm in length), increased cortical echogenicity with respect to the liver and spleen, decreased corticomedullary definition, mild bilateral renal pelvic dilations (dog is on IV fluids), and a small amount of retroperitoneal effusion just lateral and dorsal to the left kidney. There is also some echogenic fat adjacent to the left kidney.
- R/O’s include bilateral pyelonephritis, leptospirosis, ethylene glycol toxicity, rodenticide toxicity
- Any other thoughts? What would your number one rule out be for this patient?
Comments
Blood work indicative of
Blood work indicative of acute kidney injury – do you have urinalysis results? I assume the electrolytes were normal. Correct with your rule outs but would also consider acute sepsis and trauma as additional differentials. The bilateral renal pelvic dilations may just be from fluid therapy and not indicative of pyelonephritis.
Blood work indicative of
Blood work indicative of acute kidney injury – do you have urinalysis results? I assume the electrolytes were normal. Correct with your rule outs but would also consider acute sepsis and trauma as additional differentials. The bilateral renal pelvic dilations may just be from fluid therapy and not indicative of pyelonephritis.
Melissa this is a very
Melissa this is a very aggressive nephritis. Any time the pericapsular free fluid around the kidneys is seen then I am concerned for lepto or acute renal toxin. The kidneys are very swollen yet hypervascular (in other images you sent me) which means very acute. The free fluid is likely from there and likely necrosing the tubules given the renal bleeding. Coag and 25 g fna of the kidney cortex to ensure no emerging lsa but use a 25 g for best sample owing to the hypervascularity–avoid blood artifact obscuring the read…
I would Tx iv ampicillin and IM baytril, plasma transfuse would be best here, plasma expanders and gi protect. Check the bp and of course lepto titers. Tx lepto til proven otherwise. If there is the possibility then dialysis. Have to hope for lepto but it isnt guaranteed recovery if that either with these kidneys-yuck
Melissa this is a very
Melissa this is a very aggressive nephritis. Any time the pericapsular free fluid around the kidneys is seen then I am concerned for lepto or acute renal toxin. The kidneys are very swollen yet hypervascular (in other images you sent me) which means very acute. The free fluid is likely from there and likely necrosing the tubules given the renal bleeding. Coag and 25 g fna of the kidney cortex to ensure no emerging lsa but use a 25 g for best sample owing to the hypervascularity–avoid blood artifact obscuring the read…
I would Tx iv ampicillin and IM baytril, plasma transfuse would be best here, plasma expanders and gi protect. Check the bp and of course lepto titers. Tx lepto til proven otherwise. If there is the possibility then dialysis. Have to hope for lepto but it isnt guaranteed recovery if that either with these kidneys-yuck